Combination electrosurgical instrument

ABSTRACT

An instrument including a first arm, a second arm, and a blade. The first arm includes a lumen in communication with a source of irrigation fluid and one or more outlets in communication with the lumen for delivering the irrigation fluid to a surgical site. The instrument is switchable between a first configuration and a second configuration. In the first configuration, the instrument is configured to deliver a first therapy current through a distal end of the first arm, a distal end of the second arm, or both. In the second configuration, a distal end of the blade extends beyond the distal end of the first arm and beyond the distal end of the second arm.

FIELD

These teachings relate to an instrument for effecting an object oranatomical feature.

BACKGROUND

Various instruments for use in medical procedures are known; however,instrument improvements are always desired.

Some instruments are used to cut an anatomical feature; and aftercutting, other instruments are used to coagulate a bleeding anatomicalfeature. As can be imagined, time and focus is lost between switchinginstruments to cut and then coagulate an anatomical feature. It maytherefore be desirable to combine cutting and coagulating capabilitiesinto a single instrument to reduce the number of instrument swapsrequired during a medical procedure.

Some instruments, such as an energized scalpel, can provide a singleelectrosurgical modality, either a monopolar therapeutic current forcutting and coagulating an anatomical feature. Other energizedinstruments can provide a bipolar therapeutic current for coagulatingand sealing an anatomical feature. Similarly, time and focus is lostbetween switching instruments when a monopolar therapeutic current isdesired over a bipolar therapeutic current, or vice versa. It maytherefore be desirable to have a reconfigurable electrosurgicalinstrument or scalpel that has both monopolar and bipolar therapeuticcapabilities. Further specialized instruments provide an output forprecoagulating the tissue, sealing small vessels within the tissuestructure so that subsequent cutting of the tissue with a scalpel orenergized scalpel are less likely to result in bleeding.

Some instruments used for coagulating an anatomical feature such astissue can cause a significant temperature increase in the tissue, whichmay undesirably lead to tissue desiccation, tissue sticking, tissueperforation, char formation, and/or smoke generation. It may thereforebe desirable to provide an instrument that can reduce or inhibit tissuedesiccation, tissue sticking, tissue perforation, char formation, and/orsmoke generation.

Some instruments, such as forceps, are user activated and requirepressure application on one or more arms of the forceps to capture,grip, and/or grasp, an anatomical feature located between the arms.Releasing the pressure on one or both of the arms causes the arms toopen thus releasing the anatomical feature from between the arms. Thepressure applied to the arms is usually applied via finger pressure,which may cause fatigue especially during prolonged medical procedures.It may therefore be desirable to provide an instrument that can be usedto capture, grip, and/or grasp an anatomical feature without requiringapplying pressure to one or both of the arms, thus relieving userfatigue.

Some examples of instruments are disclosed in U.S. Pat. Nos. 9,023,035,8,882,756, and 6,929,641; US Patent App. Pub. Numbers 2015/0223862 and2014/0276795; and in U.S. patent application Ser. No. 14/672,525, thedisclosures of which are hereby incorporated by reference herein for allpurposes.

SUMMARY

These teachings provide an instrument that has both cutting andcoagulating capabilities. The instrument is reconfigurable so that oneor more features of the instrument can be moved or repositioned.

These teachings provide a reconfigurable electrosurgical instrument,such as a scalpel, that has both monopolar and bipolar therapeuticcapabilities.

These teachings provide an instrument that can reduce or inhibit tissuedesiccation, tissue sticking, tissue perforation, char formation, andsmoke generation.

These teachings also provide an instrument that can be used to capture,grip, and/or grasp an anatomical feature without causing user fatigue byallowing the arms of the instrument to close by releasing pressureapplied to the arms.

These teachings provide an instrument that can precoagulate tissueallowing subsequent resection or cutting with a reduced amount ofbleeding, where the cutting or resection element is incorporated intothe same device and is switchable between a first configuration and asecond configuration.

Further yet, these teachings provide an instrument comprising a firstarm, a second arm, and a blade. The first arm comprises a lumen incommunication with a source of irrigation fluid and one or more outletsin communication with the lumen for delivering the irrigation fluid to asurgical site. The instrument is switchable between a firstconfiguration and a second configuration. In the first configuration,the instrument is configured to deliver a first therapy current througha distal end of the first arm, a distal end of the second arm, or both.In the second configuration, a distal end of the blade extends beyondthe distal end of the first arm and beyond the distal end of the secondarm.

Still further yet, these teachings provide an instrument comprising afirst scalpel, a second scalpel, a first insulator, and a secondinsulator. The first scalpel comprises a first electrode and a secondelectrode. The second scalpel is located between the first electrode andthe second electrode. The first insulator is located between the firstelectrode and the second scalpel so that the first electrode and thesecond scalpel are electrically insulated from each other. The secondinsulator is located between the second electrode and the second scalpelso that the second electrode and the second scalpel are electricallyinsulated from each other. The instrument is switchable between a firstconfiguration and a second configuration. In the first configuration,the second scalpel is retracted so that a distal end of the secondscalpel does not extend beyond a distal end of the first scalpel, andthe instrument is configured to deliver a first therapy current throughthe first arm, the second arm, or both. In the second configuration, thesecond scalpel extends beyond a distal end of first electrode and adistal end of the second electrode.

These teachings provide an instrument comprising a forceps comprising afirst arm, a second arm, and a moveable blade. The first arm having afirst gripper. The second arm having a second gripper. The first arm andthe second arm cross over one another. The instrument is switchablebetween a first configuration and a second configuration. In the firstconfiguration, the instrument is configured to deliver a first therapycurrent through the first arm, the second arm, or both, and the blade isfree from extending beyond a distal end of the first arm and a distalend of the second arm. In the second configuration, the blade extendsbeyond the distal end of the first arm and the distal end of the secondarm.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1a is a perspective view of an instrument.

FIG. 1b is a perspective view of an instrument.

FIG. 2 is a perspective view of an instrument.

FIG. 3 is a perspective view of an instrument.

FIG. 4 is a perspective view of an instrument.

FIG. 5 is a perspective view of an instrument.

FIG. 6 is a perspective view of an instrument.

FIG. 7a is a cross-sectional view of the instrument of FIG. 6.

FIG. 7b is a cross-sectional view of the instrument of FIG. 6.

FIG. 7c is a cross-sectional view of the instrument of FIG. 6.

FIG. 7d is a cross-sectional view of the instrument of FIG. 6.

FIG. 7e is a cross-sectional view of the instrument of FIG. 6.

FIG. 7f is a cross-sectional view of the instrument of FIG. 6.

FIG. 8 is a cross-sectional view of an arm including a heat pipe.

FIG. 9 is a perspective view of an instrument.

FIG. 10a is a cross-sectional view of an instrument.

FIG. 10b is a cross-sectional view of an instrument.

FIG. 10c is a cross-sectional view of an instrument.

FIG. 10d is a cross-sectional view of an instrument.

FIG. 10e is a cross-sectional view of an instrument.

FIG. 10f is a cross-sectional view of an instrument.

DETAILED DESCRIPTION

The explanations and illustrations presented herein are intended toacquaint others skilled in the art with the teachings, its principles,and its practical application. Those skilled in the art may adapt andapply the teachings in its numerous forms, as may be best suited to therequirements of a particular use. Accordingly, the specific embodimentsof the present teachings as set forth are not intended as beingexhaustive or limiting of the teachings. The scope of the teachingsshould, therefore, be determined not with reference to the abovedescription, but should instead be determined with reference to theappended claims, along with the full scope of equivalents to which suchclaims are entitled. The disclosures of all articles and references,including patent applications and publications, are incorporated byreference for all purposes. Other combinations are also possible as willbe gleaned from the following claims, which are also hereby incorporatedby reference into this written description.

These teachings provide an instrument. The instrument may be a medicalinstrument. The instrument may be any instrument or device foreffecting, object or anatomical feature. Effecting may mean, forexample, holding, manipulating, engaging, moving, grasping, gripping,constricting, pushing, pulling, cutting, tearing, coagulating, sealing,cauterizing, dissecting, fulgurating, or a combination thereof an objector anatomical feature. The anatomical feature may be any anatomicalfeature, such as a vessel, tissue, vein, artery, the like, or acombination thereof. The instrument can be used in virtually anyprocedure, medically related or other. In medical procedures, theinstrument can be used in open procedures, laparoscopic procedures, orboth. The instrument can be used in orthopedic procedures, spinalprocedures, general procedures, cardiovascular procedures and/orneurological procedures. The instrument may be any instrument or devicehaving one or more arms. The instrument may be a forceps. The instrumentmay not be a forceps or may be free of forceps and/or forceps arms. Theforceps can be virtually any forceps known in the field. The instrumentmay be a tweezers. The instrument may be a cross tweezers. Theinstrument can be a scalpel having one or more scalpels. The instrumentcan be used with or without power. When used with power, the instrumentcan be an electrosurgical instrument.

One or more electrical currents, therapies, and/or signals may beprovided to the instrument. The power, the one or more electricalcurrents, therapies, and/or signals may be provided to the instrumentvia a power source. The power source may be any suitable power source.The power source may be a generator. The power source may be of the typedescribed in U.S. Pat. No. 7,282,048B2, the teachings of which arehereby incorporated by reference herein for all purposes. The one ormore electrical currents, therapies, and/or signals may be provided to,through, and/or between one or more active portions, one or more arms,one or more electrodes, one or more blades, one or more scalpels, one ormore gripping portions, a remote electrode or patient pad, or acombination thereof.

The one or more electrical currents, therapies, and/or signals providedby the power source may be monopolar energy, bipolar energy, a blendedenergy, or a combination thereof. The one or more electrical currents,therapies, and/or signals may include a cut waveform, a coagulationwaveform, and/or a blended waveform. During use, an electrical circuitmay be completed by passing monopolar energy or current from the powersource to one or more arms, one or more electrodes, one or more blades,one or more scalpels, one or more active portions, or a combinationthereof, to anatomical feature, and then to a remote electrode orpatient pad. During use, an electrical circuit may be completed bypassing bipolar energy or current from the power source to an activeelectrode or an active feature of one or more arms, one, or moreelectrodes, one or more blades, one or more scalpels, or a combinationthereof, through the anatomical feature, and to a return electrode oractive portion of one or more arms, one or more electrodes, one or moreblades, one or more scalpels, or a combination thereof. A cut waveformenergy or therapy signal may be delivered from the power source to theinstrument, and can be described as a higher current/lower voltagewaveform compared to a coagulation waveform energy or therapy signal.The coagulation waveform energy or therapy signal may be modulated orinterrupted from the power source to the instrument, and can bedescribed as a lower current/higher voltage waveform compared to the cutwaveform. The blended waveform may be a combination of a cut waveformand a coagulation waveform. The blended waveform may advantageouslyallow a user to coagulate the object or anatomical feature while alsocutting the object or anatomical feature. The blended waveform may be ofthe type described in the above mentioned U.S. Pat. No. 7,787,048B2.

Generally speaking, the instrument according to the teachings herein maybe configured and/or operable to allow a user to paint tissue with oneor more therapy currents and irrigation fluid and then switch to amonopolar, bipolar, or non-electrosurgical blade to cut thepre-coagulated anatomical feature. Alternatively, the instrument can beused to coagulate an anatomical feature once cutting has been performedto seal the anatomical feature. The instrument may provide a combinationof therapeutic currents or energy and irrigation fluid that provideshemostatic sealing of soft tissue and bone during surgery.

The instrument may be in communication with a fluid source. The sourcemay supply irrigation fluid to the instrument. The irrigation fluid maybe provided to clean a distal end of the instrument, clean a feature ofinterest, clean a surgical site, or a combination thereof. Theirrigation fluid may be a conductive fluid that may function toelectrically conduct the one or more electrical therapies or signals.The irrigation fluid may be saline. The irrigation fluid may benon-conductive. Non-conductive fluid may be less preferred than aconductive fluid, however, the use of a non-conductive fluid may providecertain advantages over the use of a conductive fluid, which may includereducing the occurrence of tissue sticking to the electrode and coolingof the electrode and/or tissue. An example of non-conductive irrigationfluid is deionized water.

The fluid source may supply suction to the instrument. That is, a singleline, or another line in communication with the fluid source may supplysuction to the instrument. The suction may function to evacuate fluidfrom a surgical site. For example, the suction may function to removesmoke, air, or both from the feature of interest. The same fluid sourcemay provide both the irrigation fluid and the suction, or the irrigationmay be provided by one fluid source and the suction or fluid evacuationmay be provided by another fluid source. The irrigation fluid and thesuction can be provided to the instrument at the same time or atdifferent times (e.g., first irrigation fluid and then suction, or viceversa).

The instrument may include an effector. The effector may function toeffect an object or anatomical feature. For example, the effector maypermit holding, manipulating, engaging, moving, grasping, gripping,constricting, pushing, pulling, cutting, tearing, coagulating, sealing,cauterizing, dissecting, fulgurating, or a combination thereof an objector anatomical feature. The effector may include one or more features ofa forceps, a tweezers, a scalpel, an electrode or a combination thereof.The effector may include one or more of the arms, blades, scalpels,electrodes, insulators, or a combination thereof described herein.

The instrument, the effector, the one or more of the arms, blades,scalpels, electrodes, insulators, or a combination thereof may bemoveable or reconfigurable relative to a frame of reference. The frameof reference may be any suitable reference point, plane, axis, and/orfeature. For example, the frame of reference may be one or more arms, anopposing arm, a blade, one or more of the scalpels, an opposing scalpel,one or more electrodes, a user, a patient, a surgical site, the anatomy,or a combination thereof.

The instrument, the effector, or both may be operable in one or moreconfigurations. The instrument, the effector, the one or more of thearms, blades, scalpels, electrodes, insulators, or a combination thereofmay be moveable or reconfigurable between two or more configurations.The instrument, the effector, the one or more of the arms, blades,scalpels, electrodes, insulators, or a combination thereof may bemoveable or reconfigurable between a first configuration and a secondconfiguration. As used herein, either the first configuration or thesecond configuration may be the steady state configuration.

In the first configuration, the second configuration, or both, the firstarm, the second arm, or both may be moved towards or away from acentrally located blade. In the first configuration, the secondconfiguration, or both, a blade or scalpel may extend beyond a distalend of a first electrode, arm and/or scalpel and a distal end of asecond electrode, arm, and/or scalpel. In the first configuration, thesecond configuration, or both, a blade or scalpel may not extend or mayfree from extending beyond a distal end of a first electrode, arm and/orscalpel and a distal end of a second electrode, arm, and/or scalpel.

The first configuration, the second configuration, or both may be amonopolar electrosurgical configuration, a bipolar electrosurgicalconfiguration, or both. In the first configuration, the secondconfiguration, or both, a suitable therapy current (e.g., a monopolarsignal or therapy or a bipolar therapy signal or therapy) may bedelivered from the power source to or through one or more blades, arms,scalpels, electrodes, active portions, or a combination thereof. In thefirst configuration, the second configuration, or both, a suitabletherapy current may be delivered from the power source between two ormore of the following: blades, arms, scalpels, electrodes, activeportions, a remote electrode or patient pad, or a combination thereof.

In the first configuration, the second configuration, or both, asuitable therapy current may be prevented from passing Of beingdelivered from the power source and one or more of the following:blades, arms, scalpels, electrodes, active portions, a remote electrodeor patient pad, or a combination thereof.

The instrument may be operable in a simultaneous configuration whichcomprises any of the first configurations and the second configurationdescribed herein. In a simultaneous configuration, a first therapycurrent can be passed between a first arm and a second arm while at thesame time a second therapy current is passed from the blade to a remoteelectrode or patient pad. In a simultaneous configuration, a firsttherapy current can be passed between a first arm and a second arm andthen a second therapy current can be passed from the blade to a remoteelectrode while the first therapy current is free from passing betweenthe first arm and the second arm.

The instrument, the effector, or both may include one or more arms. Theone or more arms may be configured to and/or may function to effect anobject or anatomical feature. The one or more arms may function todeliver one or more therapeutic currents or signals, irrigation fluid,suction, or a combination thereof to a surgical site or anatomicalfeature. The one or more arms may function to remove heat from asurgical site or anatomical feature. The one or more arms may be free ofgripping devices and/or features for grasping and/or gripping ananatomical feature. For example, the one or more arms may not be aforceps and/or arms of a forceps.

One or more of the arms may be moveable or reconfigurable. Moveable orreconfigurable may mean that the position of one or more of the arms canbe changed. Moveable or reconfigurable may mean that one or both of thearms can be moved or extended away from a hand piece of the instrument,a surgeon or operator using the instrument, one or more other arms,blades, electrodes, or a combination thereof. Moveable or reconfigurablemay mean that one or more of the arms can be moved or extended towards apatient or surgical site. Moveable may mean that one or both of the armscan be retracted or moved towards a hand piece, a surgeon or operatorusing the instrument, one or more other arms, blades, electrodes, or acombination thereof. Moveable or reconfigurable may mean that one ormore of the arms can be vertically moved relative to one or more otherarms, blades, electrodes, or a combination thereof (e.g., moveable orreconfigurable up and down). Moveable or reconfigurable may mean thatone or more of the arms are laterally moveable or displaceable towardsor away from one or more other arms, blades, electrodes, or acombination thereof (e.g., moveable or reconfigurable side to side).Moveable or reconfigurable may mean that one or more of the arms can bediagonally or along a path that is irregular (e.g., non-linear) relativeto one or more other arms, blades, electrodes, or a combination thereof(e.g., moveable or reconfigurable up and down). Moveable orreconfigurable may mean that one or more of the arms are rotatable abouttheir longitudinal axis. Moveable or reconfigurable may mean anycombination of arm movements described herein.

In some configurations, the arms may be static (e.g., not moveable). Insome configurations the arms may be spaced apart and/or held at a fixeddistance apart suitable for painting a site of interest with RF energyor a suitable therapy current to electrically effect an anatomicalfeature. The one or more arms may be electrically conductive and/or mayinclude one or more electrodes or active portions so that a therapycurrent can be passed from a power source to, from and/or between theone or more arms, electrodes, blades, scalpels, remote electrodes, or acombination thereof The one or more electrodes or active portions may belocated at or near a distal end of the corresponding one or more arms.

The one or more arms may be made of a suitable material for use inmedical procedures. For example, the one or more arms may be made ofsteel, stainless steel, carbon steel, or a combination thereof Each ofthe one or more arms may include a material with a thermal conductivityand the thermal conductivity of the arms may be the same; one arm may behigher than the other working arm; or both. The one or more arms mayinclude one or more materials along the length of the working arm. Forexample, the arms may be entirely made of stainless steel. Preferably,each arm includes two or more materials. For example, the arms may havea base material of stainless steel and the working arms may be coatedwith an insulating material such as silicone or polytetrafluoroethylene(PTFE). The one or more arms may include any material that is safe foruse in a surgical procedure, and preferably in an electrosurgicalprocedure. The one or more arms may include metals, plastics, a polymer,an elastomer, gold, silver, copper, titanium, aluminum, iron basedmetals, stainless steel, silicone, polytetrafluoroethylene (PTFE),insulating polymers, rubber, or a combination thereof. Preferably, eacharm is substantially coated with an insulating material except for acontact region between the two working arms where the working armscontact each other. The one or more arms may be coated in regions wherethe user contacts the arms. The one or more arms may include aninsulating material where the arms contact a blade electrode so thatheat from the blade electrode is not transferred to the arms. Thematerial of the arms, a coating on the arms, a housing of the arms, or acombination thereof may prevent a dissipation of heat from the arms. Theone or more arms may be insulated from the blade so that thermal energyor electrical energy is prevented from being transferred to the arms(e.g., the blade, arms, or both may include an insulating coating).

The one or more arms are made from a material that can withstandrepeated sterilization in high-temperature autoclaves. However, the armsmay also be made of material suitable to be used once and thendiscarded, such as plastic, for example.

The one or more arms may be substantially straight; may include one ormore angles, bends or arcs; or a combination thereof. The one or morearms may be substantially rigid; substantially flexible; substantiallyresilient; or a combination thereof. The one or more arms may bemalleable or reconfigurable so that at least a portion of the arm can bemanually shaped, bent, and/or distorted by a user.

As used herein, the one or more scalpels, blades, and arms may includeone or more active portions and one or more inactive portions. The oneor more active portions may be any portion that, supplies or conductspower, signals, current, or a combination thereof. The one or moreactive portions may be substantially surrounded by inactive portions orportions that are insulated. The inactive portion may be any portionthat does not supply power, that is insulated, or both. The inactiveportion may be any portion that may prevent a transfer of power throughincidental contact and thus are insulated so that an incidental transferof power does not occur. For example, an outside of the arms, blades,scalpels, electrodes, or a combination thereof may be coated with aninsulating material so that if the arms, blades, scalpels, electrodesaccidentally contact tissue proximate to the tissue of interest theproximate tissue is not subjected to a transfer of power. The inactiveportion and the active portion may be made of different materials,coated with different materials, or both.

The one or more arms may include one or more lumen. The one or morelumen may function to provide or define a conduit or passageway. The oneor more lumen may function to provide a conduit or passageway forallowing irrigation fluid, suction, or both to pass from one or moresources to a surgical site or anatomical feature. The one or more lumenmay function to provide for a heat pipe to remove heat from a surgicalsite and/or region of a corresponding arm.

The one or more arms may include any number of lumen. For example, theone or more arms may together or individually include one or more lumenfor delivering irrigation fluid from one or more sources to a surgicalsite; one or more lumen for delivering suction from one or more sourcesto a surgical site; one or more lumen functioning as a heat pipe; or acombination thereof. For example, one arm can have one or more lumenwith outlets to allow irrigation fluid and/or suction to exit and one ormore sealed lumen functioning as a heat pipe within the same arm. Insome configurations, one or more of the arms may be free of lumen. Forexample, it may be desirable in some configurations for an arm to bemade of a suitable solid material.

The one or more arms may include one or more outlets. The one or moreoutlets may function to provide for the irrigation fluid and/or suctionto be passed and/or delivered from the corresponding lumen to a surgicalsite. The one or more outlets may be any suitable size The one or morearms may comprise any number of outlets. The one or more outlets may belocated at or near a distal end of a respective arm. The one or moreoutlets may face forward from a distal end; may face laterally from adistal end; or both. The one or more outlets may face laterally inwards(e.g., towards a blade and/or one or more other arms). The one or moreoutlets may face laterally outwards (e.g., away from a blade ands or oneor more other arms). One or both of the arms may include one or moreoutlets that face any direction described herein.

The instrument, the effector, the one or more arms, or a combinationthereof may include one or more heat pipes. The heat pipe may functionto transfer heat from a region of a greater concentration of heat to aregion with a lower concentration of heat. The heat pipe may function tocarry heat from a first location to a second location where the heat isdissipated. The heat pipe may carry heat from a distal end of theinstrument, arm, or both to a proximal end (i.e., an end of theinstrument and/or arm closest to the user), a central portion (e.g., aportion of the arm between the distal end and the proximal end), or acombination of both of the instrument, the arms, or both. The heat pipemay be connected to one or more electrodes of a corresponding arm,blade, scalpel, or a combination thereof. The heat pipe may be locatedin a portion of the one or more arms that become heated so that heat istransferred from the arms to the heat pipe. The heat pipe may be locatedin a corresponding lumen in the one or more arms. The one or more heatpipes may be hermetically sealed, self-contained, a partial vacuum, or acombination thereof. The one or more heat pipes may include a fluid toabsorb heat, transport heat, reject heat, dissipate heat, or acombination thereof. The fluid may be located in a heat pipe located ina lumen, or the fluid may be located in the lumen. The one or more heatpipes may be filled with water, alcohol, sodium, ammonia, ethanol,methanol, or other suitable fluid. The fluid may undergo one or morephase changes and preferably two or more phase changes (e.g.,evaporation, condensation, or both) that assist in removing heat fromthe arms, the electrosurgical device, or both. The fluid may assist intransporting heat from a first end of the heat pipe to a second end ofthe heat pipe; the first end may be a higher temperature than the secondend. The first end may be a distal end and the second end may be aproximal end, or vice versa. The one or more heat pipes may function sothat a fluid sealed within the heat pipe when heated evaporates from thedistal end and moves to the proximal end where the fluid condenses andreleases the heat. The heat may be removed via one or more heat sinks ata proximal end of the arm or heat pipe. The condensate then moves fromthe proximal end back to the distal end and the cycle repeats.

The heat pipe may be sufficiently long and/or have a sufficiently largecross-sectional thickness (e.g., diameter) so that fluid travels fromthe distal end of the heat pipe to the proximal end of the heat pipe sothat the fluid is cooled. The heat pipe may be sufficiently long and/orhave a sufficient cross-sectional thickness so that evaporated fluidtravels from the hot end of the heat pipe (e.g., distal end to the coolend of the heat pipe (e.g., proximal end) where the fluid condenses. Theheat pipe may be sufficiently long and/or have a sufficientcross-sectional thickness so that the proximal end remains sufficientlycool so that the evaporated fluid condenses. The length and/orcross-sectional thickness may be sufficiently large so that the heatpipe continues to cool over an extended duration of use (e.g., about 10minutes or more, about 20 minutes or more, about 30 minutes or more, oreven about 1 hour or more of substantially continuous use). The fluidwhen condensed may travel from the cool end to the hot end via capillaryaction, centrifugal force, gravity, or a combination thereof. The heatpipe may include a sufficient amount of fluid so that the heat pipesubstantially maintains a constant temperature of the working arms, theelectrosurgical device, or both for the duration of use. The heat pipemay include a sufficient amount of fluid so that the temperature of theheat pipe raises by a temperature of about 40° C. or less, about 30° C.or less, about 20° C. or less, or about 10° C. or less over the durationof use, over an extended duration of use, or both. Each of the one ormore heat pipes may be connected to one or more heat sinks.

The instrument, the effector, the arms, the heat pipes or a combinationthereof may include one or more heat sinks. The one or more heat sinksmay be connected to the one or more heat pipes or arms. Each heat pipemay be connected to a heat sink, have an integral heat sink, or both.The heat pipes may extend through the heat sinks and the heat sinks mayremove heat from the heat pipe or arm through thermal contact. The heatpipe may transfer heat to the heat sink via a heat transfer medium(e.g., a thermal paste) so that heat is transferred from the heat pipeto the heat sink. The heat sink and the heat pipes may be made of thesame material. The heat sink may be an extended portion of the heatpipe, or arm that acts to dissipate heat. For example, a coil, fin orother extended shape may extend from an end of the heat pipe or arm andmay allow for heat transfer. The heat sink may be located on the “coldend” or evaporation end of the heat pipe, on the proximal end of theheat pipe, the proximal end of the arms, the proximal end of theinstrument, or a combination thereof. The heat sink may increase thesurface area of each of the one or more heat pipes. The heat sink mayinclude one or more heat exchange surfaces that transfers heat into thesurrounding environment or ambient cooling fluid, such as room air forexample. The surface area of the heat sink surface may be about twotimes or more, about three times or more, or even about four times ormore than the surface area of the heat pipe. The heat sink may be and/orinclude fins, baffles, an increase in surface area, tubes, plates, ribs,or a combination thereof. The heat sink may be an integral part of thearms so that movement of the arms moves the heat sink or vice versa. Theheat sink, heat pipe, or both may be partially and or entirely shieldedfrom contact by the user so that heat from the heat pipe, the heat sink,or both does not directly contact the user. The heat sink may be made ofthe same material as the heat pipe. The heat sink may be made of amaterial with high conductivity, higher conductivity than the heat pipe,or both. The heat sink may use natural convection, forced convection, orboth to dissipate heat. Movement of the instrument during use may forceair over the heat sink, the heat exchange surface, or both and transferheat into the surrounding environment. The heat sink may be connected toor may include an active circuit element such as a Peltier chip. Whenpower is applied to a Peltier chip, heat may move from one side to theother, so that one side gets cooler while the other gets hotter. The“hot side” may be connected to a heat sink to transfer heat to thesurrounds so that the “hot side” remains at ambient temperature, whilethe cool side goes below an ambient temperature of the surroundings. Theheat sink may be connected to or may include a motor cooling system thatuses suction to draw in ambient air and pass the ambient air over ahousing such as disclosed in Applicant's commonly owned US PatentApplication Publication No. US 2016-0081699, the disclosure of which ishereby incorporated by reference in its entirety for all purposes.

The one or more arms may include one or more grippers (See e.g., FIG.9). The one or more grippers may function to grip or otherwise effect ananatomical feature. The one or more grippers may be conductive so thatan electrosurgical signal, therapy or signal can be provided thereto.The one or more grippers may be non-conductive or include portions thatare non-conductive. The one or more grippers may include grippingportions having teeth, serrations, or other friction surfaces in orderto grip an anatomical feature. The one or more grippers may have paddletype tips. A paddle type tip may be a rectangular tip with cornersremoved. The one or more grippers may have a tear drop shape that allowsthe tip to be dug into a surface of an anatomical feature to grasp smallbleeders and the larger flats for sealing vessels. An external coatingmay be applied to the grippers to prevent accidental tissue modificationin small, cramped surgical areas. The one or more grippers may havestandoffs on internally facing surfaces to prevent shorting duringactivation of the instrument on small tissue bundles, for example.

The instrument, the effector, or both may include one or more blades.The one or more blades may be configured to and/or may function toeffect an object or anatomical feature. The one or more blades mayfunction to deliver one or more therapeutic currents or signals to asurgical site or anatomical feature of interest. The one or more bladesmay function to manipulate, engage, move, push, pull, cut, tear,coagulate, seal, cauterize, dissect, fulgurate, or a combination thereofan object or anatomical feature. The one or more blades may be anycutting tool, blade, electrode, blade electrode, scalpel, knife, and/orseparate member that may be used in or used during a medical or surgicalprocedure. The one or more blades may be any cutting device that may beextended and retracted between the one or more arms, the effector, or acombination thereof.

The one or more blades may be selectively reciprocated to cut a featureof interest located, gripped, or placed between the arms. The one ormore blades may be made of any material that may be sharpened; is strongenough to cut tissue, veins, arteries, an anatomical feature, a featureof interest, or a combination thereof; is biocompatible; may conductelectricity; or a combination thereof. The one or more blades, thedistal end of the one or more blades, or both, may conduct energy sothat the one or more blades, the distal end, or both can be used as ablade electrode. The distal end of the one or more blades may be blunt.The distal end of the one or more blades may be sharp. The distal end ofthe one or more blades may be curved, linear, angled, or irregularlyshaped. The one or more blades, the distal end of the one or more bladesor both may extend beyond a distal end of the arms or other blades whenthe one or more blades are in a steady state, in a first configurationor in a second configuration. The one or more blades, the distal end ofthe one or more blades or both may permanently extend beyond a distalend of the gripping assembly.

One or more of the blades may be moveable or reconfigurable. Moveable orreconfigurable may mean that the position of one or more of the bladescan be changed. Moveable or reconfigurable may mean that one or more ofthe blades can be moved or extended away from a hand piece of theinstrument, a surgeon or operator using the instrument, one or morearms, blades, electrodes, or a combination thereof. Moveable orreconfigurable may mean that one or more of the blades can be moved orextended towards a patient or surgical site. Moveable may mean that oneor more of the blades can be retracted or moved towards a hand piece, asurgeon or operator using the instrument, one or more arms, blades,electrodes, or a combination thereof. Moveable or reconfigurable maymean that one or more of the blades can be vertically moved relative toone or more arms, blades, electrodes, or a combination thereof (e.g.,moveable or reconfigurable up, and down). Moveable or reconfigurable maymean that one or more of the blades are laterally moveable ordisplaceable towards or away from one or more arms, blades, electrodes,or a combination thereof (e.g., moveable or reconfigurable side toside). Moveable or reconfigurable may mean that one or more of theblades can be diagonally or along a path that is irregular (e.g.,non-linear) relative to one or more arms, blades, electrodes, or acombination thereof (e.g., moveable or reconfigurable up and down).Moveable or reconfigurable may mean that one or more of the blades arerotatable about their longitudinal axis. Moveable may mean that a gapbetween the arms (e.g., a gap where the blade fits) can be increased,decreased, widened, narrowed, or a combination thereof. Moveable maymean that an outer width of the instrument, effector, or both, from anoutside of one arm to an outside of another arm, can be increased,decreased, widened, narrowed, or a combination thereof. Moveable maymean that a gap or distance between a central, longitudinal axis of eacharm can be increased, decreased, widened, narrowed, or a combinationthereof. Moveable or reconfigurable may mean any combination of blademovements described herein.

The blade may be located between one or more arms, above one or more ofthe arms, below one or more of the arms, or a combination thereof. Theblade may be electrically connected to a power source so that a therapycurrent or signal can be passed from the power source to the blade or anactive portion of the blade, through an object or anatomical feature, toone or more of the arms, and back to the power source. The blade may beelectrically connected to a power source so that a therapy current orsignal can be passed from the power source to the blade, through anobject or anatomical feature, to a remote electrode such as a patientpad. The blade may be connected to a power source, but may bedisconnected from the power source and used as a non-electrosurgicalscalpel. The blade may be free from any connections to a power source,and may be used as a non-electrosurgical scalpel.

The instrument, the effector, or both may include a connector. Theconnector may function to connect or maintain a connection between theone or more arms and the blade. The connector may be an insulator. Theconnector may be insert molded around the blade and the one or morearms. The connector may function to restrict or prevent the one or morearms from moving. The connector may function to provide for the one ormore arms or blade to move within a predetermined range.

The instrument, the effector, or both may include one or more scalpels.A scalpel may comprise one scalpel, or one or more scalpels (e.g., twoscalpels). The one or more scalpels may be configured to and/or mayfunction to effect an object or anatomical feature. The one or morescalpels may function to deliver one or more therapeutic currents orsignals to a surgical site or anatomical feature of interest. The one ormore scalpels may function to manipulate, engage, move, push, pull, cut,tear, coagulate, seal, cauterize, dissect, fulgurate, or a combinationthereof an object or anatomical feature. The one or more scalpels may beany cutting tool, blade, electrode, blade electrode, scalpel, knife,and/or separate member that may be used in or used during a medical orsurgical procedure. The one or more scalpels may be any cutting devicethat may be extended and retracted between the one or more scalpels,electrodes, or both.

The one or more scalpels may be selectively reciprocated to cut afeature of interest. The one or more scalpels may be made of anymaterial that may be sharpened; is strong enough to cut tissue, veins,arteries, an anatomical feature, a feature of interest, or a combinationthereof; is biocompatible; may conduct electricity; or a combinationthereof. The one or more scalpels, the distal end of the one or morescalpels, or both, may conduct energy so that the one or more scalpels,the distal end, or both can be used as an electrode. The distal end ofthe one or more scalpels may be blunt. The distal end of the one or morescalpels may be sharp. The distal end of the one or more scalpels may becurved, linear, angled, or irregularly shaped. The one or more scalpels,the distal end of the one or more scalpels or both may extend beyond adistal end of one or more scalpels in a steady state, in a firstconfiguration or in a second configuration. The one or more scalpels,the distal end of the one or more scalpels or both may permanentlyextend beyond a distal end of the gripping assembly.

One or more of the scalpels may be moveable or reconfigurable. Moveableor reconfigurable may mean that the position of one or more of thescalpels can be changed. Moveable or reconfigurable may mean that one ormore at the scalpels can be moved or extended away from a hand piece ofthe instrument, a surgeon or operator using the instrument, one or morescalpels, or a combination thereof. Moveable or reconfigurable may meanthat one or more of the scalpels can be moved or extended towards apatient or surgical site. Moveable may mean that one or more of thescalpels can be retracted or moved towards a hand piece, a surgeon oroperator using the instrument, one or more scalpels, or a combinationthereof. Moveable or reconfigurable may mean that one or more of thescalpels can be vertically moved relative to one or more scalpels (e.g.,moveable or reconfigurable up and down). Moveable or reconfigurable maymean that one or more of the scalpels are laterally moveable ordisplaceable towards or away from one or more scalpels moveable orreconfigurable side to side). Moveable or reconfigurable may mean thatone or more of the scalpels can be diagonally or along a path that isirregular (e.g., non-linear) relative to one or more scalpels (e.g.,moveable or reconfigurable up and down). Moveable or reconfigurable maymean that one or more of the scalpels are rotatable about theirlongitudinal axis. Moveable or reconfigurable may mean any combinationof scalpels movements described herein.

A scalpel may be located between one or more other scalpels, above oneor more of other scalpels, below one or more other scalpels, or acombination thereof. The one or more scalpels may be electricallyconnected to a power source so that a therapy current or signal can bepassed from the power source to the scalpel, through an object oranatomical feature, to one or more of the arms and back to the powersource. The scalpel may be electrically connected to a power source sothat a therapy current or signal can be passed from the power source tothe scalpel, through an object or anatomical feature, to a remoteelectrode such as a patient pad. The scalpel may be free from anyconnections to a power source, and may be used as a non-electrosurgicalscalpel.

The figures of this disclosure illustrate exemplarity instruments andfeatures that are described throughout this disclosure. It is understoodthat the instruments and features illustrated in the figures arenon-exhaustive, and that certain feature described in this disclosuremay not be shown in the figures. It is also understood that a featureillustrated in one or more of the figures is not necessary limited tothat one particular figure, instrument, and/or embodiment. In otherwords, it is within the of this disclosure that some features,components, and/or instruments illustrated in one or more of the figuresof this disclosure can be added, replaced, combined, substituted and/ormodified with other features, components, and/or instruments illustratedin other figures of this disclosure and/or described in other sectionsof this disclosure.

FIG. 1a illustrates an instrument 100. The instrument 100 comprises aneffector 102 comprising a first arm 104, a second arm 106, and a blade108. The blade 108 in FIG. 1a is illustrated in a first configuration178, where the blade 108 is retracted in a direction 168 so that adistal end of the blade 108 does not extend beyond a distal end of thefirst arm 104 and/or a distal end of the second arm 106. The first arm104 includes a lumen 110 in communication with a source 112 of fluid.The first arm 104 includes one or more outlets 114 in communication withthe lumen 110 for delivering the fluid from the source 112 to at a siteof interest, such as a surgical site. The second arm 106 includes alumen 118 in communication with the source 112. The second arm 106includes one or more outlets 120 in communication with the lumen 118 fordelivering the fluid from the source 120 to surgical site. The first arm104 and the second arm 106 are connected together with a connector 122.The first arm 104 and the second arm 106 are connected to a power source134 so that a therapy current C can be delivered or passed betweenactive portions on the arms 104, 106.

FIG. 1b illustrates the effector 102 with the blade 108 in a secondconfiguration 180 where the blade is extended in direction 170 so that adistal end of the blade 108 extends beyond a distal end of the first arm104 and/or the second arm 106. The blade 108 is connected to a powersource 134 so that a therapy current C can be delivered or passed fromthe power source 134 to the blade 108 and ultimately to a remoteelectrode 124 or patient pad.

FIG. 2 illustrates fluid F delivered to a surgical site from the source112 (FIG. 1a ) via the one or more outlets 114, 120. FIG. 2 alsoillustrates a therapy current C delivered from the blade 108 to one orboth of the arms 104, 106. The therapy current C may travel from theblade 108, through the fluid F and to one or both of the arms 104, 106.

FIG. 3 illustrates that one or both of the arms 104, 106 are moveable sothat the one or both of the arms 104, 106 can be moved towards the blade108 as shown, and also away from the blade 108 (c.f. FIG. 2).

FIG. 4 illustrates that die blade 108 can be a non-electrosurgical bladefor cutting an object or anatomical feature.

FIG. 5 illustrates a therapy current C passing from the blade 108 to aremote electrode 124 or patient pad. A therapy current C can also bepassed from the blade 108 to one or both of the arms 104, 106. This mayoccur in succession (i.e., one after another).

FIG. 6 illustrates among the first arm 104 and the second arm 106, theeffector 102 includes one or more lumen for delivering irrigation fluidfrom a source; one or more lumen for delivering suction from a source;one or more lumen including a heat pipe; or a combination thereof. Whilenon-exhaustive, various lumen configurations are illustrated in FIGS. 7a-7 f.

FIG. 7a illustrates a cross section of the effector 102 of FIG. 6showing the first arm 104, the second arm 106, and the blade 108. Thefirst arm 104 includes a lumen 110, and the second arm 106 includes alumen 118. Irrigation fluid may be supplied from the source 112 (FIG. 1)to a surgical site through one of the lumen 110, 118 via outlets in thecorresponding arm. The other lumen 110, 118 may also be connected to thesource 112 for supplying irrigation fluid to the surgical site viaoutlets in the arm, or the other lumen may include a heat pipe, or mayalso be connected to the source 112 for supplying suction to thesurgical site.

FIG. 7b illustrates the first arm 104 having lumen 110, and the secondarm 106 having lumen 118 and lumen 148. Irrigation fluid may be suppliedfrom the source 112 (FIG. 1) to a surgical site through one or morelumen 110, 118, 148 via one or more outlets in the corresponding arm(s).Any remaining lumen 110, 118, 148 may include a heat pipe, or may beconnected to the source 112 to supply suction to the surgical site.

FIG. 7c illustrates the first arm 104 having lumen 110, and the secondarm 106 having lumen 118, lumen 148, and lumen 150. Irrigation fluid maybe supplied from the source 112 (FIG. 1) to a surgical site through oneor more lumen 110, 118, 148, 150 via one or more outlets in thecorresponding arm(s). Any remaining lumen 110, 118, 148, 150 may includea heat pipe, or may supply suction to a surgical site from the source112.

FIG. 7d illustrates the first arm 104 having lumen 110 and 152, and thesecond arm 106 having any configuration of lumen disclosed herein.Alternatively, the second arm 106 can be free of lumen. Irrigation fluidmay be supplied from the source 112 (FIG. 1) to a surgical site throughat least one of the lumen 110 and 152. Any remaining lumen 110 and 152in the first arm 104 and the second arm 106 may include a heat pipe, ormay supply suction to a surgical site from the source 112.

FIG. 7c illustrates the first arm 104 having lumen 110, lumen 152, andlumen 154, and the second arm 106 having any configuration of lumendisclosed herein. Irrigation fluid may be supplied from the source 112(FIG. 1) to a surgical site through at least one of the lumen 110, 152,and 154. Any remaining lumen 110, 152, and 154 in the first arm 104 andthe second arm 106 may include a heat pipe, or may supply suction to thesurgical site from the source 112.

FIG. 8 illustrates one of the arms 104, 106 having a heat pipe 157. Theheat pipe 157 can be located within or adjacent one or more other lumencontaining irrigation fluid and/or suction. The heat pipe 157 includes asealed lumen 159 having a wick. The lumen 159 is charged with a fluidthat can change phase. During use, when an end 161 (e.g., evaporationend; distal end) of the heat pipe 157 is exposed to a heat source, thefluid in the wick evaporates and thus enters the gaseous phase G as itexpands and flows towards the second end 163 (e.g., condensation end;proximal end). The second end 163 may be optionally in thermalcommunication with one or more heat sinks 165 or another type of heatexchanger that draws heat out of the gas G. The gas G then condensesback into a liquid L at the second end 163 and is absorbed by the wick.The liquid L is then wicked back in a direction towards the first end161 (e.g., evaporation end).

FIG. 9 illustrates an instrument 100. The instrument 100 comprises afirst arm 104, a second arm 106, and a blade 108. The first arm includesa first gripper 130, and the second arm 106 includes a second gripper132. The instrument 100 includes a switch 136 for moving the blade 108between an extended position and a retracted position. The extendedposition is illustrated in FIG. 9 where a distal end of the blade 108 isextended beyond a distal end of the first arm 104 the second arm 106.The first arm 104, the second arm 106, and/or the blade 108 may beconnected to a power source 134. The instrument 100 includes a switch138 for supplying a therapy current from the power source 134 to thefirst arm 104, the first gripper 130, the second arm 106, the secondgripper 132, the blade 108, or a combination thereof. A therapy currentmay be delivered between the first arm 104 and/or first gripper 130 andthe second arm 106 and/or second gripper 132. A therapy current C may bedelivered from the blade 108 to a remote electrode 124. A therapycurrent may be delivered from the blade 108 to one or both of the firstarm 104 and/or first gripper 130 and the second arm 106 and/or secondgripper 132. The first arm 104 includes a first force receiving section140, and the second arm 106 includes a second force receiving section142. Applying a force to one or both of the force receiving sections140, 142 causes the arms 104, 106 and the grippers 130, 132 to separateand move away from each other and from the blade 108.

FIG. 10a illustrates an instrument 100 comprising a first scalpel 156and a second scalpel 158. The first scalpel 156 comprises a firstelectrode 160 and a second electrode 162. A first insulator 164 islocated between the first electrode 160 and the second scalpel 158 sothat the first electrode 160 is electrically insulated from the secondscalpel 158. A second insulator 166 is located between the secondelectrode 162 and the second scalpel 158 so that the second electrode162 is electrically insulated from the second scalpel 158. The secondscalpel 158 is illustrated in a first configuration 178 where the secondscalpel 158 is retracted in a direction 168 so that a distal end of thesecond scalpel 158 does not extend beyond a distal end of the first andsecond electrodes 160, 162. A therapy current C supplied by a source 134(FIG. 1) can be passed between the first and second electrodes 160, 162.

FIG. 10b illustrates an instrument 100 where the second scalpel 158 isin a second configuration 180. In the second configuration 180, thesecond scalpel 158 is extended in a distal direction 170 so that adistal end of the second scalpel 158 extends beyond a distal end of thefirst and second electrodes 160, 162. A therapy current C supplied by asource 134 (FIG. 1) can be passed between the second scalpel 158 and aremote electrode 124.

FIG. 10c illustrates an instrument 100 where the second scalpel 158 ispositioned relative to the first and second electrodes 160, 162 so thata therapy current C supplied by a source 134 (FIG. 1) can be passedbetween the second scalpel 158 and the electrodes 160, 162.

FIG. 10d illustrates the second scalpel 158 in the second configurationbeyond a distal end of the first and second electrodes 160, 162. Thesecond scalpel can be a non-electrosurgical blade for cutting an objector anatomical feature.

FIG. 10e illustrates a second scalpel 158 comprising a first electrode172 and a second electrode 174. An insulator 176 separates theelectrodes 172, 174. The second scalpel 158 is illustrated in a firstconfiguration 178 where the second scalpel 158 is retracted in aproximal direction 168 so that a distal end of the second scalpel 158does not extend beyond a distal end of the electrodes 160, 162. Atherapy current C supplied by a source 134 (FIG. 1) can be passedbetween the first and second electrodes 160, 162.

FIG. 10f illustrates the second scalpel 158 in a second configuration180 where the second scalpel 158 is extended in a distal direction 170so that a distal end of the second scalpel 158 extends beyond a distalend of the electrodes 160, 162. A therapy current C can be passedbetween the first and second electrodes 172,174.

Any numerical values recited herein include all values from the lowervalue to the upper value in increments of one unit provided that thereis a separation of at least 2 units between any lower value and anyhigher value. As an example, if it is stated that the amount of acomponent or a value of a process variable such as, for example,temperature, pressure, time and the like is, for example, from 1 to 90,preferably from 20 to 80, more preferably from 30 to 70, it is intendedthat values such as 15 to 85, 22 to 68, 43 to 51, 30 to 32 etc. areexpressly enumerated in this specification. For values which are lessthan one, one unit is considered to be 0.0001, 0.001, 0.01 or 0.1 asappropriate. These are only examples of what is specifically intendedand all possible combinations of numerical values between the lowestvalue and the highest value enumerated are to be considered to beexpressly stated in this application in a similar manner. As can beseen, the teaching of amounts expressed as “parts by weight” herein alsocontemplates the same ranges expressed in terms of percent by weight.Thus, an expression in the Detailed Description of the Teachings of arange in terms of at “‘x’ parts by weight of the resulting polymericblend composition” also contemplates a teaching of ranges of samerecited amount of “x” in percent by weight of the resulting polymericblend composition.”

Unless otherwise stated, all ranges include both endpoints and allnumbers between the endpoints. The use of “about” or “approximately” inconnection with a range applies to both ends of the range. Thus, “about20 to 30” is intended to cover “about 20 to about 30”, inclusive of atleast the specified endpoints.

The disclosures of all articles and references, including patentapplications and publications, are incorporated by reference for allpurposes. The term “consisting essentially of” to describe a combinationshall include the elements, ingredients, components or steps identified,and such other elements ingredients, components or steps that do notmaterially affect the basic and novel characteristics of thecombination. The use of the terms “comprising” or “including” todescribe combinations of elements, ingredients, components or stepsherein also contemplates embodiments that consist essentially of theelements, ingredients, components or steps.

Plural elements, ingredients, components or steps can be provided by asingle integrated element, ingredient, component or step. Alternatively,a single integrated element, ingredient, component or step might bedivided into separate plural elements, ingredients, components or steps.The disclosure of “a” or “one” to describe an element, ingredient,component or step is not intended to foreclose additional elements,ingredients, components or steps.

It is understood that the above description is intended to beillustrative and not restrictive. Many embodiments as well as manyapplications besides the examples provided will be apparent to those ofskill in the art upon reading the above description. The scope of theteachings should, therefore, be determined not with reference to theabove description, but should instead be determined with reference tothe appended claims, along with the full scope of equivalents to whichsuch claims are entitled. The disclosures of all articles andreferences, including patent applications and publications, areincorporated by reference for all purposes. The omission in thefollowing claims of any aspect of subject matter that is disclosedherein is not a disclaimer of such subject matter, nor should it beregarded that the inventors did not consider such subject matter to bepart of the disclosed inventive subject matter.

1) An instrument comprising: i. a first arm, the first arm includes alumen in communication with a source of irrigation fluid, the first armincludes one or more outlets in communication with the lumen fordelivering the irrigation fluid from the source to a surgical site; ii.a second arm; and iii. a blade; wherein the instrument is switchablebetween a first configuration and a second configuration, wherein in thefirst configuration, the instrument is configured to deliver a firsttherapy current through a distal end of the first arm, a distal end ofthe second arm, or both, and wherein in the second configuration, adistal end of the blade extends beyond the distal end of the first armand beyond the distal end of the second arm. 2) The instrument of claim1, wherein the blade is an electrosurgical blade. 3) The instrument ofclaim 1, wherein the blade is a non-electrosurgical scalpel. 4) Theinstrument of claim 1, wherein the first arm extends generally parallelto the second arm. 5) The instrument of claim 1, wherein the second armincludes a lumen in communication with the source of irrigation fluid,the second arm includes one or more outlets in communication with thelumen of the second arm for delivering the irrigation fluid to thesurgical site. 6) The instrument of claim 5, wherein the first arm, thesecond arm, or both comprise a lumen in communication with a source ofsuction. 7) (canceled) 8) (canceled) 9) The instrument of claim 1,wherein the blade is moveable, and wherein in the first configuration, adistal end of the blade is retracted proximal to the distal end of thefirst arm and proximal to the distal end the second arm. 10) Theinstrument of claim 1, wherein the second configuration is a monopolarelectrosurgical configuration where a second therapy current isdelivered from the blade to a remote electrode. 11) The instrument ofclaim 1, wherein the second configuration is a bipolar electrosurgicalconfiguration where a second therapy current is delivered between theblade and one or both of the first arm and the second arm. 12) Theinstrument of claim 10, wherein one or both of the first arm and thesecond arm are moved towards the blade in the second configuration. 13)(canceled) 14) (canceled) 15) An instrument comprising: i. a firstscalpel comprising: a. a first electrode, and b. a second electrode; ii.a second scalpel located between the first electrode and the secondelectrode; iii. a first insulator located between the first electrodeand the second scalpel so that the first electrode and the secondscalpel are electrically insulated from each other; and iv. a secondinsulator located between the second electrode and the second scalpel sothat the second electrode and the second scalpel are electricallyinsulated from each other, wherein the instrument is switchable betweena first configuration and a second configuration, wherein in the firstconfiguration, the second scalpel is retracted so that a distal end ofthe second scalpel does not extend beyond a distal end of the firstscalpel, and the instrument is configured to deliver a first therapycurrent through the first arm, the second arm, or both, and wherein inthe second configuration, the second scalpel extends beyond a distal endof first electrode and a distal end of the second electrode. 16)(canceled) 17) The instrument of claim 15, wherein the second scalpel isa non-electrosurgical scalpel. 18) (canceled) 19) (canceled) 20) Theinstrument of claim 15, wherein the second configuration is a monopolarelectrosurgical configuration where a second therapy current isdelivered from the second scalpel to a remote electrode. 21) Theinstrument of claim 15, wherein the second configuration is a bipolarelectrosurgical configuration where a second therapy current isdelivered between the second scalpel and one or both of the firstelectrode and the second electrode. 22) The instrument of claim 15,wherein in the first configuration, a first therapy current is deliveredbetween the first electrode and the second electrode, and in the secondconfiguration, a therapy current is prevented from being deliveredbetween the first electrode and the second electrode. 23) The instrumentof claim 15, wherein the second scalpel is a bipolar electrosurgicalscalpel having a third electrode and a fourth electrode wherein thefirst configuration is a bipolar electrosurgical configuration where thefirst therapy current is delivered between the first electrode and thesecond electrode, and wherein the second configuration is a bipolarelectrosurgical configuration where a second therapy current isdelivered between the third electrode and the fourth electrode. 24) Aninstrument comprising: a forceps comprising: i. a first arm, the firstarm having a first gripper; ii. a second arm, the second arm having asecond gripper; and iii. a moveable blade; wherein the first arm and thesecond arm cross over one another, wherein the instrument is switchablebetween a first configuration and a second configuration, wherein in thefirst configuration, the instrument is configured to deliver a firsttherapy current through the first arm, the second arm, or both, and theblade is free from extending beyond a distal end of the first arm andbeyond a distal end of the second arm, and wherein in the secondconfiguration, the blade extends beyond the distal end of the first armand beyond the distal end of the second arm. 25) The instrument of claim24, wherein the first arm includes a force receiving section and thesecond arm includes a force receiving section, and wherein applying aforce to one or both of the force receiving sections causes the firstgripper and the second gripper to separate. 26) (canceled) 27)(canceled) 28) (canceled) 29) (canceled) 30) The instrument of claim 24,wherein the second configuration is a monopolar electrosurgicalconfiguration where a second therapy current is delivered from the bladeto a remote electrode. 31) The instrument of claim 24, wherein thesecond configuration is a bipolar electrosurgical configuration where asecond therapy current is delivered between the blade and one or both ofthe first arm and the second arm. 32) (canceled) 33) The instrument ofclaim 24, wherein the blade is arranged substantially parallel to thefirst gripper and to the second gripper.